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Bighetti ACC, Cestari TM, Paini S, Pomini KT, Buchaim DV, Ortiz RC, Júnior RSF, Barraviera B, Bullen IRFR, Garlet GP, Buchaim RL, de Assis GF. Efficacy and safety of a new heterologous fibrin biopolymer on socket bone healing after tooth extraction: An experimental pre-clinical study. J Clin Periodontol 2024. [PMID: 38685818 DOI: 10.1111/jcpe.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
AIM To assess the efficacy of heterologous fibrin biopolymer (HFB) in promoting alveolar bone healing after tooth extraction in rats. MATERIALS AND METHODS The upper right incisors of 48 Wistar rats were extracted. Toothless sockets were filled with HFB (HFBG, n = 24) or blood clot (BCG, n = 24). The tooth extraction sites were subjected to micro-computed tomography (micro-CT), histological, histomorphometric and immunohistochemical (for Runt-related transcription factor 2/Runx2 and tartrate-resistant acid phosphatase/TRAP) analyses on days 0, 7, 14 and 42 after extraction. RESULTS Socket volume remained similar between days 0 and 14 (69 ± 5.4 mm3), except in the BCG on day 14, when it was 10% lower (p = .043). Although the number of Runx2+ osteoblasts was high and similar in both groups (34 × 102 cells/mm2), the HFBG showed lower inflammatory process and osteoclast activity than BCG at 7 days. On day 14, the number of Runx2+ osteoblasts remained high and similar to the previous period in both groups. However, osteoclast activity increased. This increase was 55% lower in the HFBG than BCG. In the BCG, the presence of an inflammatory process and larger and numerous osteoclasts on day 14 led to resorption of the alveolar bone ridge and newly formed bone. On day 42, numbers of Runx2+ osteoblast and TRAP+ osteoclasts decreased dramatically in both groups. Although the BCG exhibited a more mature cortical bone formation, it exhibited a higher socket reduction (28.3 ± 6.67%) and smaller bone volume (37 ± 5.8 mm3) compared with HFBG (socket reduction of 14.8 ± 7.14% and total bone volume of 46 ± 5.4 mm3). CONCLUSIONS HFB effectively suppresses osteoclast activity and reduces alveolar bone resorption compared with blood clot, thus preventing three-dimensional bone loss, particularly during the early healing period. HFB emerges as a promising biopharmaceutical material for enhancing healing processes after tooth extraction.
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Affiliation(s)
| | - Tania Mary Cestari
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Suelen Paini
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Karina T Pomini
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marilia, Brazil
| | - Daniela Vieira Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marilia, Brazil
- Teaching and Research Coordination of the Medical School, University Center of Adamantina (UNI-FAI), Adamantina, Brazil
| | - Rafael Carneiro Ortiz
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rui Seabra Ferreira Júnior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ Estadual Paulista, UNESP), Botucatu, São Paulo, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, São Paulo, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ Estadual Paulista, UNESP), Botucatu, São Paulo, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, São Paulo, Brazil
| | - Izabel R F R Bullen
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Gustavo Pompermaier Garlet
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rogério Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo, Brazil
| | - Gerson F de Assis
- Department of Biological Sciences, Bauru School of Dentristy, University of São Paulo, Bauru, São Paulo, Brazil
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Miller PC, Schulte LJ, Kotkar K. Successful Suture-Free Repair of Left Ventricular Rupture Using the EVARREST Patch. Tex Heart Inst J 2024; 51:e238277. [PMID: 38452332 DOI: 10.14503/thij-23-8277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Left ventricular free wall rupture is a lethal complication of myocardial infarction. Although emergent surgical repair is the treatment of choice, the method of repair remains highly individualized. This report presents a case of spontaneous coronary artery dissection in a patient with Turner syndrome that led to left ventricular free wall rupture and was successfully repaired on cardiopulmonary bypass using a suture-free technique with the EVARREST Fibrin Sealant Patch.
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Affiliation(s)
- Paighton C Miller
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Linda J Schulte
- Department of Cardiothoracic Surgery, Missouri Baptist Medical Center, St Louis, Missouri
| | - Kunal Kotkar
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St Louis, Barnes-Jewish Hospital, St Louis, Missouri
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Vigliar MFR, Marega LF, Duarte MAH, Alcalde MP, Rosso MPDO, Ferreira Junior RS, Barraviera B, Reis CHB, Buchaim DV, Buchaim RL. Photobiomodulation Therapy Improves Repair of Bone Defects Filled by Inorganic Bone Matrix and Fibrin Heterologous Biopolymer. Bioengineering (Basel) 2024; 11:78. [PMID: 38247955 PMCID: PMC10813421 DOI: 10.3390/bioengineering11010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Biomaterials are used extensively in graft procedures to correct bone defects, interacting with the body without causing adverse reactions. The aim of this pre-clinical study was to analyze the effects of photobiomodulation therapy (PBM) with the use of a low-level laser in the repair process of bone defects filled with inorganic matrix (IM) associated with heterologous fibrin biopolymer (FB). A circular osteotomy of 4 mm in the left tibia was performed in 30 Wistar male adult rats who were randomly divided into three groups: G1 = IM + PBM, G2 = IM + FB and G3 = IM + FB + PBM. PBM was applied at the time of the experimental surgery and three times a week, on alternate days, until euthanasia, with 830 nm wavelength, in two points of the operated site. Five animals from each group were euthanized 14 and 42 days after surgery. In the histomorphometric analysis, the percentage of neoformed bone tissue in G3 (28.4% ± 2.3%) was higher in relation to G1 (24.1% ± 2.91%) and G2 (22.2% ± 3.11%) at 14 days and at 42 days, the percentage in G3 (35.1% ± 2.55%) was also higher in relation to G1 (30.1% ± 2.9%) and G2 (31.8% ± 3.12%). In the analysis of the birefringence of collagen fibers, G3 showed a predominance of birefringence between greenish-yellow in the neoformed bone tissue after 42 days, differing from the other groups with a greater presence of red-orange fibers. Immunohistochemically, in all experimental groups, it was possible to observe immunostaining for osteocalcin (OCN) near the bone surface of the margins of the surgical defect and tartrate-resistant acid phosphatase (TRAP) bordering the newly formed bone tissue. Therefore, laser photobiomodulation therapy contributed to improving the bone repair process in tibial defects filled with bovine biomaterial associated with fibrin biopolymer derived from snake venom.
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Affiliation(s)
- Maria Fernanda Rossi Vigliar
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil; (M.F.R.V.); (D.V.B.)
| | - Lais Furlaneto Marega
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
| | - Marco Antonio Hungaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (M.A.H.D.); (M.P.A.)
| | - Murilo Priori Alcalde
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (M.A.H.D.); (M.P.A.)
| | - Marcelie Priscila de Oliveira Rosso
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), Sao Paulo State University (University Estadual Paulista, UNESP), Botucatu 18610-307, Brazil; (R.S.F.J.); (B.B.)
- Graduate Programs in Tropical Diseases and Clinical Research, Botucatu Medical School (FMB), Sao Paulo State University (UNESP–University Estadual Paulista), Botucatu 18618-687, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), Sao Paulo State University (University Estadual Paulista, UNESP), Botucatu 18610-307, Brazil; (R.S.F.J.); (B.B.)
- Graduate Programs in Tropical Diseases and Clinical Research, Botucatu Medical School (FMB), Sao Paulo State University (UNESP–University Estadual Paulista), Botucatu 18618-687, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
| | - Daniela Vieira Buchaim
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil; (M.F.R.V.); (D.V.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
| | - Rogerio Leone Buchaim
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil; (M.F.R.V.); (D.V.B.)
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
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Bajwa MS, Jackson R, Dhanda J, Tudur Smith C, Shaw RJ, Schache AG. Determining the Effectiveness of Fibrin Sealants in Reducing Complications in Patients Undergoing Lateral Neck Dissection (DEFeND): A Randomised External Pilot Trial. Cancers (Basel) 2023; 15:5073. [PMID: 37894440 PMCID: PMC10605578 DOI: 10.3390/cancers15205073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES High-quality randomised controlled trials (RCT) to support the use of Fibrin Sealants (FS) in neck dissection (ND) are lacking. The DEFeND trial assessed critical pilot/feasibility questions and signals from clinical outcomes to inform a future definitive trial. PATIENTS AND METHODS The study design piloted was a blinded surgical RCT. All participants underwent unilateral ND for head and neck cancer. Interventional arm: ND with application of FS. CONTROL ARM ND alone. Feasibility outcomes included recruitment, effectiveness of blinding, protocol adherence and evaluating administrative processes. Clinical outcomes included surgical complications (primary outcome), drainage volume, time to drain removal, length of hospital stay, pain and the Neck Dissection Impairment Index. RESULTS Recruitment completed ahead of time. Fifty-three patients were recruited, and 48 were randomised at a rate of 5.3 patients/month. Blinding of patients, research nurses and outcome assessors was effective. Two protocol deviations occurred. Two patients were lost to follow-up. The mean (SD) Comprehensive Complication Index in the interventional arm was 6.5 (12.8), and it was 9.9 (14.2) in the control arm. The median (IQR) time to drain removal (days) was shorter in the interventional arm (2.67 (2.42, 3.58) vs. 3.40 (2.50, 4.27)). However, this did not translate to a clinically significant reduction in median (IQR) length of hospital stay in days (intervention: 3.48 (2.64, 4.54), control: 3.74 (3.11, 4.62)). CONCLUSION The proposed trial design was effective, and a definitive surgical trial is feasible. Whilst there was a tendency for FS to improve clinical outcomes, the effect size did not reach clinical or statistical significance. (ISRCTN99181100).
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Affiliation(s)
- Mandeep S. Bajwa
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool L69 3BX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
| | - Richard Jackson
- Liverpool Clinical Trials Centre, The University of Liverpool, Liverpool L69 3BX, UK
| | - Jagtar Dhanda
- Head & Neck Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK
| | - Catrin Tudur Smith
- Institute of Population Health, The University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool L69 3GF, UK
| | - Richard J. Shaw
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
| | - Andrew G. Schache
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
- Head & Neck Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool L9 7AL, UK
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Attar BM, Naeini MHM, Abdinian M. Investigation of the effect of fibrin glue as a sealant in the unilateral alveolar bone grafting successes. Dent Res J (Isfahan) 2023; 20:60. [PMID: 37388305 PMCID: PMC10300265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/11/2021] [Accepted: 01/25/2022] [Indexed: 07/01/2023] Open
Abstract
Background Bone grafting is the primary treatment for the alveolar cleft. Due to the reduced complications by the sealant materials, this study aimed to evaluate fibrin glue's effect on the success rate of unilateral alveolar bone grafting. Materials and Methods This study was a single-blind clinical trial performed on 20 patients with a unilateral alveolar cleft. Patients were randomly divided into groups: group A patients as a control group underwent bone grafting without fibrin glue, and in Group B, patients were grafted using fibrin glue. The subject was followed up through routine examination and the cone-beam computed tomography systems technique for up to 4 months. Paired t-test and Chi-square tests were used to analyze the data and the P < 0.05 was considered the significance threshold. Results The mean age, gender, and cleft side distribution did not represent significant differences. Before surgery, the average alveolar cleft volume in Group A and B patients was 0.95 ± 0.25 cm3 and 0.99 ± 0.22 cm3, respectively, which was not statistically different. After the surgery procedure, the alveolar cleft volume in Group A and B patients was determined to be 0.31 ± 0.10 cm3 and 0.23 ± 0.11 cm3, which represented 66.7% ± 8.9% cm3 and 76.2 ± 11.4 cm3 bone formation, respectively, with no remarkable difference. Our examination did not reveal any necrosis and infection in both groups. However, despite no dehiscence observation in fibrin glue treatment patients, one subject showed dehiscence complication in the control group. Conclusion According to results, fibrin glue may increase the percentage of bone volume formed and prevent dehiscence.
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Affiliation(s)
- Bijan Movahedian Attar
- Dental Research Center, Department of Oral and Maxillofacial Surgery, Craniofacial and Cleft Research Center, Dental Research Institute, Isfahan, Iran
| | - Mohammad Hossein Manouchehri Naeini
- Dental Research Center, Department of Maxillofacial Surgery, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Abdinian
- Dental Implant Research Center, Department of Oral and Maxillofacial Radiology, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Bueno CRDS, Tonin MCC, Buchaim DV, Barraviera B, Ferreira Junior RS, Santos PSDS, Reis CHB, Pastori CM, Pereira EDSBM, Nogueira DMB, Cini MA, Rosa Junior GM, Buchaim RL. Morphofunctional Improvement of the Facial Nerve and Muscles with Repair Using Heterologous Fibrin Biopolymer and Photobiomodulation. Pharmaceuticals (Basel) 2023; 16:ph16050653. [PMID: 37242436 DOI: 10.3390/ph16050653] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Peripheral nerve injuries impair the patient's functional capacity, including those occurring in the facial nerve, which require effective medical treatment. Thus, we investigated the use of heterologous fibrin biopolymer (HFB) in the repair of the buccal branch of the facial nerve (BBFN) associated with photobiomodulation (PBM), using a low-level laser (LLLT), analyzing the effects on axons, muscles facials, and functional recovery. This experimental study used twenty-one rats randomly divided into three groups of seven animals, using the BBFN bilaterally (the left nerve was used for LLLT): Control group-normal and laser (CGn and CGl); Denervated group-normal and laser (DGn and DGl); Experimental Repair Group-normal and laser (ERGn and ERGl). The photobiomodulation protocol began in the immediate postoperative period and continued for 5 weeks with a weekly application. After 6 weeks of the experiment, the BBFN and the perioral muscles were collected. A significant difference (p < 0.05) was observed in nerve fiber diameter (7.10 ± 0.25 µm and 8.00 ± 0.36 µm, respectively) and axon diameter (3.31 ± 0.19 µm and 4.07 ± 0.27 µm, respectively) between ERGn and ERGl. In the area of muscle fibers, ERGl was similar to GC. In the functional analysis, the ERGn and the ERGI (4.38 ± 0.10) and the ERGI (4.56 ± 0.11) showed parameters of normality. We show that HFB and PBM had positive effects on the morphological and functional stimulation of the buccal branch of the facial nerve, being an alternative and favorable for the regeneration of severe injuries.
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Affiliation(s)
- Cleuber Rodrigo de Souza Bueno
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Dentistry School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
| | - Maria Clara Cassola Tonin
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Universidade Estadual Paulista, UNESP), Botucatu 18610-307, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Universidade Estadual Paulista), Botucatu 18618-687, Brazil
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Universidade Estadual Paulista, UNESP), Botucatu 18610-307, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Universidade Estadual Paulista), Botucatu 18618-687, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- UNIMAR Beneficent Hospital (HBU), University of Marilia (UNIMAR), Marília 17525-160, Brazil
| | | | - Eliana de Souza Bastos Mazuqueli Pereira
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
| | - Dayane Maria Braz Nogueira
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Marcelo Augusto Cini
- Medical School, University of West Paulista (UNOESTE), Guarujá 11441-225, Brazil
| | | | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo 05508-270, Brazil
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Kondo A, Shinozaki T, Nishiya Y, Okano W, Tomioka T, Hayashi R, Ogawa R, Matsuura K. Factors affecting polyglycolic acid sheet engraftment success for covering mucosal defects from head and neck surgery. Jpn J Clin Oncol 2023:7136608. [PMID: 37093674 DOI: 10.1093/jjco/hyad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/05/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Polyglycolic acid (PGA) sheets have been used with fibrin glue to cover extensive mucosal defects in oral and pharyngeal surgery; however, the sheets can fall off before wound healing is completed. Hence, prolonged fasting is often recommended in such patients. However, there are few studies on the factors that shape PGA sheet engraftment. We studied sheet engraftment rates considering these factors. METHODS All consecutive cases of oral surgery in 2013-21 in which the defect was covered with fibrin glue and Neoveil® or Neoveil Nano® PGA sheets were identified. The loss of all sheets was defined as an engraftment failure. Multiple logistic regression analysis was conducted to identify whether the PGA-sheet type, application site, defect size and postoperative fasting duration predicted engraftment. RESULTS Overall, 137 patients were identified (mean age, 73 years; 57% male). The surgeries were conducted with Neoveil® in 66% of the patients; the most common site was the buccal mucosa (25%), and the mean defect size and fasting duration were 709 mm2 and 4 days, respectively. The engraftment rate was 76%. Neoveil Nano® PGA sheets were associated with a 2.8-fold better engraftment rate than Neoveil® (univariate: 87 vs. 70%, P = 0.032; multivariate: 95% confidence intervals = 1.067-7.410, P = 0.036). Other variables, including fasting duration, were not predictive of engraftment. CONCLUSIONS This is the largest case series of patients with head and neck cancer who underwent fibrin glue-PGA sheet defect coverage. The fasting duration did not influence engraftment. Therefore, early oral intake is not contraindicated in such patients.
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Affiliation(s)
- Akatsuki Kondo
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
- Department of Plastic, Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukio Nishiya
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Wataru Okano
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Abbade LPF, Barraviera SRCS, Silvares MRC, Lima ABBDCO, Haddad GR, Gatti MAN, Medolago NB, Rigotto Carneiro MT, dos Santos LD, Ferreira RS, Barraviera B. Treatment of Chronic Venous Ulcers With Heterologous Fibrin Sealant: A Phase I/II Clinical Trial. Front Immunol 2021; 12:627541. [PMID: 33708219 PMCID: PMC7940668 DOI: 10.3389/fimmu.2021.627541] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Heterologous fibrin sealant (HFS) consists of a fibrinogen-rich cryoprecipitate extracted from Bubalus bubalis buffalo blood and a thrombin-like enzyme purified from Crotalus durissus terrificus snake venom. This study evaluated the safety and immunogenicity of HFS, estimated the best dose, and assessed its preliminary efficacy in the treatment of chronic venous ulcers (CVU). Methods A phase I/II non-randomized, single-arm clinical trial was performed on 31 participants, accounting for a total of 69 active CVUs. All ulcers were treated with HFS, essential fatty acid, and Unna boot for 12 weeks. The outcomes assessed were: (1) primary safety, immunogenicity analyses, and confirmation of the lowest safe dose; (2) secondary promising efficacy by analyzing the healing process. Immunogenicity was evaluated using the serum-neutralizing (IgM and IgG) and non-neutralizing (IgA and IgE) antibody techniques against the product. The immuno-detection of IgE class antibodies was assessed using dot-blot assay before and at the end of treatment. Positive samples on dot-blot assays were subsequently analyzed by western blotting to verify the results. Results No severe systemic adverse events related to the use of HFS were observed. Local adverse events potentially related to treatment include ulcer pain (52%), peri-ulcer maceration (16%), peri-ulcer pruritus (12%), critical colonization (8%), peri-ulcer eczema (4%), the opening of new ulcers (4%), and increased ulcerated area 4%). Neutralizing and non-neutralizing antibodies did not show significant deviations at any of the evaluated time points. Blot assays showed that all patients presented negative immunological reactions, either before or after treatment, with the thrombin-like enzyme component. In addition, two participants showed a positive immunological reaction to the cryoprecipitate component, while another two were positive before and during treatment. Regarding the secondary outcomes of preliminary efficacy, a total healing and significant reduction of the area was observed in 47.5 and 22%, respectively. A qualitative improvement was observed in the wound beds of unhealed ulcers. Conclusions The investigational HFS bioproduct proved to be safe and non-immunogenic with a good preliminary efficacy for the treatment of CVU, according to the protocol and doses proposed. A multicentric phase III clinical trial will be necessary to verify these findings.
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Affiliation(s)
- Luciana P. F. Abbade
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Nursing, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Clinical Research, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Silvia Regina Catharino Sartori Barraviera
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Maria Regina Cavariani Silvares
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Ana Beatriz B. de C. O. Lima
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Gabriela R. Haddad
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Márcia A. N. Gatti
- Nursing School of Sagrado Coração University (UNISAGRADO), Bauru, Brazil
| | - Natália Bronzatto Medolago
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Márcia Tonin Rigotto Carneiro
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Lucilene Delazari dos Santos
- Graduate Program in Clinical Research, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Rui Seabra Ferreira
- Graduate Program in Clinical Research, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
| | - Benedito Barraviera
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Clinical Research, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil
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Puia SA, Hilber EM, Garcia-Blanco M. Randomized Clinical Trial Comparing Three Local Hemostatic Agents for Dental Extractions in Patients under Chronic Anticoagulant Therapy - A Comparative Study. Ann Maxillofac Surg 2020; 10:292-296. [PMID: 33708570 PMCID: PMC7943974 DOI: 10.4103/ams.ams_276_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/27/2020] [Accepted: 08/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Oral anticoagulants are widely used worldwide for many systemic diseases. Recent oral surgical protocols suggest that therapeutic levels of the anticoagulant drug should be maintained for simple dental extractions because bleeding complications could be managed with proper local hemostasis. The aim of the present study was to compare bleeding complication of three different local hemostatic agents for dental extractions without interrupting drug administration in patients undergoing oral Vitamin K antagonist chronic anticoagulant therapy. Material and Methods Randomized control trial of three hemostatic agents for dental extractions, in patients under oral anticoagulant therapy without drug interruption. The present study included 240 patients with international normalized ratio between 1.5 and 3.5. Patients took their anticoagulation drug normally. A single surgeon performed calibrated simple dental extractions and applied a plug of bismuth subgallate (BS), fibrin tissue adhesive (FTA) or microfibrillar collagen (MC), assigned randomly. Statistical analysis of bleeding between the groups was performed using the Chi-square test. Results There was no hemorrhagic complication in the BS group, and only one in the FTA group. However, in the MC group, 10 patients (12.5%) suffered postoperative bleeding. Data analysis showed statistical differences between the MC group and the other two groups (P < 0.05). Discussion BS and FTA showed similar clinical effectiveness and were more effective than MC for the control of postoperative bleeding in oral anticoagulated patients.
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Affiliation(s)
- Sebastian Ariel Puia
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Matias Hilber
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Matias Garcia-Blanco
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
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Ceylan SM, Erdoğan C, Sozen T, Kanmaz MA, Disikirik I, Jafarov S, Tahir E. The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation. Ear Nose Throat J 2019; 100:483S-488S. [PMID: 31625404 DOI: 10.1177/0145561319882123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.
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Affiliation(s)
- Seyit Mehmet Ceylan
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ceren Erdoğan
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Tevfik Sozen
- Department of Otorhinolaryngology, School of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Mahmut Alper Kanmaz
- Department of Otorhinolaryngology, School of Medicine, 390721SANKO University, Gaziantep, Turkey
| | - Ilyas Disikirik
- Department of Ear Nose Throat Disease, Sani Konukoglu Hospital Practice and Research Center, Gaziantep, Turkey
| | - Shamkhal Jafarov
- Department of Ophtalmology, Duztepe Yasam Hospital, Gaziantep, Turkey
| | - Emel Tahir
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey
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Abstract
Surgery for ossification of the ligamentum flavum (OLF) comes with a relatively high risk of dural tear. We report a 50-year-old woman, who presented with symptomatic spinal stenosis from OLF at T11-T12 and lower lumbar spondylosis for which a single stage posterior decompression and instrumented fusion of both sites was done. Removal of the OLF resulted in a small dural tear with intact arachanoid which was covered using a fibrin sealant. In the first post-operative day, the patient's neurology started deteriorating. An MR scan was done to look for hematoma. It showed the spinal cord herniating out of the thecal sac at the operated level. Emergency re-operation was done to reduce the herniation and the dural defect was repaired. The patient gradually recovered to her best functional status. Based on this experience, we advise primary repair of inadvertent durotomies.
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Affiliation(s)
| | - Mark Tan
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital , Singapore
| | | | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital , Singapore
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12
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Gondé H, Le Gac C, Gillibert A, Bottet B, Laurent M, Sarsam M, Hervouët C, Varin R, Baste JM. Feedback on the use of three surgical sealants for preventing prolonged air leak after robot-assisted anatomical lung resection. J Thorac Dis 2019; 11:2705-2714. [PMID: 31463097 DOI: 10.21037/jtd.2019.06.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prolonged air leak (PAL) is the most common complication after lung resection. Several surgical sealants have been developed to reduce PAL, including fibrin-based (FS), polyethylene glycol-based (PEGS) and polyglycolic acid-based (PGAS) sealants. In this work we report our experience of surgical sealant use after robot-assisted lung resection. Methods A 7-year retrospective study was conducted, including patients who had robot-assisted lobectomy or segmentectomy. Data were collected using a prospective national database. The use of surgical sealants was recorded in traceability sheets. Results PAL occurred in 60 of the 299 patients included. American Society of Anesthesiologists score (ASA) and index of prolonged air leak (IPAL) were higher for patients with sealants. In this group, operative time, chest drain duration and length of stay were significantly longer. PAL occurrence was significantly associated to sealant in univariate analysis (odds ratio =1.88, 95% CI: 1.07 to 3.36, P=0.03) but the association was slightly decreased when adjusting on IPAL and ASA score (Odds ratio =1.70, 95% CI: 0.94 to 3.10, P=0.08). Comparing sealants, more segmentectomies were performed in patients with PGAS (P=0.0013) and their operative time was shorter (P=0.0002). PAL occurrences were not different. Length of stay (P=0.0045) and operative time (P=0.0002) were longer in patients with PEGS who had more postoperative complications (P=0.024). Conclusions This study did not identify a positive effect of surgical sealants for preventing PAL. However it highlighted the need to rationalize their use.
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Affiliation(s)
- Henri Gondé
- Department of Pharmacy, Rouen University Hospital, Normandie Univ, UNIROUEN, U1234, F 76000 Rouen, France
| | - Constance Le Gac
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Normandie Univ, UNIROUEN, F 76000 Rouen, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, F 76000 Rouen, France
| | - Marc Laurent
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, F 76000 Rouen, France
| | - Charles Hervouët
- Department of Pharmacy, Rouen University Hospital, F 76000 Rouen, France
| | - Rémi Varin
- Department of Pharmacy, Rouen University Hospital, Normandie Univ, UNIROUEN, U1234, F 76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandie Univ, UNIROUEN, U1096, F 76000 Rouen, France
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13
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Hatchell A, Meathrel K, Farrokhyar F, Hynes N. A Prospective Randomized Controlled Trial of Aspiration and Fibrin Sealant Use Versus Aspiration Alone in the Treatment of Dorsal Wrist Ganglia. Plast Surg (Oakv) 2019; 27:22-28. [PMID: 30854358 DOI: 10.1177/2292550318800325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Multiple treatments for dorsal wrist ganglia (DWG) exist but have high recurrence rates. We investigated whether aspiration followed by injection of Tisseel is more effective at reducing the DWG recurrence rate than aspiration alone. Methods Adults with untreated DWG were randomly assigned to aspiration alone (A) or aspiration followed by Tisseel injection (AT). Patients were measured at baseline, 1, 6, and 12 months. Primary outcome was the rate of recurrence. Secondary outcomes included recurrent ganglion size and maximum pain experienced from the ganglion. Continuous data were compared with Student t tests and Mann-Whitney U tests. Categorical data were compared with χ2 tests and Fisher exact tests. Treatment effect was reported as relative risk or mean differences (MD) with 95% confidence intervals. Results Seventy-nine patients were randomized to the A (n = 39) or AT (n = 40) group. Twenty-five patients were lost to follow-up. There were no differences in recurrence risk between groups at 1, 6, or 12 months (P > .05). Ganglia were significantly smaller for both groups at 1 month versus baseline (P < .001). The A group demonstrated a significantly larger decrease in size at 1 month versus the AT group (MD = 0.75 cm2, 95% confidence interval: 0.07-1.43, P = .03). Both groups experienced significantly less pain at 1, 6, and 12 months (P < .03), but this was not significantly different between groups. Conclusion Aspiration and Tisseel injection does not decrease DWG recurrence versus aspiration alone. Both interventions produced a significant decrease in pain. Although aspiration alone carries a high recurrence risk, it may provide sufficient symptomatic relief for patients with DWG.
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Affiliation(s)
- Alexandra Hatchell
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kimberly Meathrel
- Division of Plastic Surgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Forough Farrokhyar
- Departments of Surgery & Heath, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nicolas Hynes
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Gerken ALH, Dobroschke J, Reißfelder C, Hetjens S, Braun V, Di Monta G, Jakob J, Hohenberger P, Nowak K, Herrle F. Tissue sealants for the prevention of lymphoceles after radical inguinal lymph node dissection in patients with melanoma: A systematic review and individual patient data meta-analysis. J Surg Oncol 2019; 119:728-736. [PMID: 30674074 DOI: 10.1002/jso.25366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/11/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative lymphoceles and further wound complications occur frequently after radical inguinal lymph node dissection (ILND). In various studies, tissue sealants have shown to reduce the incidence of postoperative morbidity. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of tissue sealants in reducing the incidence of postoperative lymphoceles following ILND in patients with melanoma was conducted. Individual patient data was requested to pool the data for meta-analysis appropriately. RESULTS Thousand seven hundred twenty-nine manuscripts were screened for eligibility. Six RCTs published between 1986 and 2012 were identified including 194 patients for ILND. Only four RCTs were included in the meta-analysis. No study properly defined the term "lymphocele." Tissue sealants failed to influence the duration of drain placement (mean difference [MD] = -3.05 days; z = 1.18; P = 0.24), total drainage volume (MD = 598.39 mL; z = 1.49; P = 0.14), the incidence of postoperative seroma, wound infection and skin necrosis. CONCLUSIONS No improvement was identified with the use of tissue sealants, however, a valid comparison of the results of included trials was difficult owing to the lack of a definition of the term "lymphocele." Other surgical techniques and trials using validated endpoint definitions are required to reevaluate these findings.
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Affiliation(s)
- Andreas L H Gerken
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jakob Dobroschke
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Christoph Reißfelder
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volker Braun
- Library, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gianlica Di Monta
- Department of Surgery, Melanoma, Soft Tissues, Head and Neck, Skin Cancers, National Cancer Institute of Naples, Naples, Italy
| | - Jens Jakob
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,Department of General, Vascular and Thoracic Surgery, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Florian Herrle
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Feldman DS, Osborne S. Fibrin as a Tissue Adhesive and Scaffold with an Angiogenic Agent (FGF-1) to Enhance Burn Graft Healing In Vivo and Clinically. J Funct Biomater 2018; 9:E68. [PMID: 30486230 PMCID: PMC6306864 DOI: 10.3390/jfb9040068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022] Open
Abstract
There is a need for a strategy to reduce scarring in meshed skin graft healing leading to a better cosmetic result without a significant increase in cost. The strategy in this paper is to increase the closure rate of a meshed skin graft to reduce scarring, which should also decrease the infection rate. Specifically, we used fibrin glue to attach all parts of the graft to the wound bed and added in an angiogenic growth factor and made the fibrin porous to further help the growth of blood vessels from the wound bed into the graft. There was a 10-day animal study and a one-month clinical study. Neither making the fibrin porous or adding an angiogenic agent (i.e., fibroblast growth factor-1 (FGF-1)) seemed to make a significant improvement in vivo or clinically. The use of fibrin on a meshed skin graft appears to speed up the regenerative healing rate leading to less scarring in the holes in the mesh. It appears to shorten the healing time by five days and keep the tissue stiffness close to normal levels vs. the doubling of the stiffness by the controls. A larger clinical study, however, is needed to definitively prove this benefit as well as the mechanism for this improvement.
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Affiliation(s)
- Dale S Feldman
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Scott Osborne
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Abstract
BACKGROUND Postoperative pancreatic fistula is one of the most frequent and potentially life-threatening complications following pancreatic resections. Fibrin sealants are introduced to reduce postoperative pancreatic fistula by some surgeons. However, the use of fibrin sealants during pancreatic surgery is controversial. This is an update of a Cochrane Review last published in 2016. OBJECTIVES To assess the safety, effectiveness, and potential adverse effects of fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery. SEARCH METHODS We searched trial registers and the following biomedical databases: the Cochrane Library (2018, Issue 4), MEDLINE (1946 to 12 April 2018), Embase (1980 to 12 April 2018), Science Citation Index Expanded (1900 to 12 April 2018), and Chinese Biomedical Literature Database (CBM) (1978 to 12 April 2018). SELECTION CRITERIA We included all randomized controlled trials that compared fibrin sealant (fibrin glue or fibrin sealant patch) versus control (no fibrin sealant or placebo) in people undergoing pancreatic surgery. DATA COLLECTION AND ANALYSIS Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio (OR) for very rare outcomes), and the mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). MAIN RESULTS We included 11 studies involving 1462 participants in the review.Application of fibrin sealants to pancreatic stump closure reinforcement after distal pancreatectomyWe included seven studies involving 860 participants: 428 were randomized to the fibrin sealant group and 432 to the control group after distal pancreatectomy. Fibrin sealants may lead to little or no difference in postoperative pancreatic fistula (fibrin sealant 19.3%; control 20.1%; RR 0.96, 95% CI 0.68 to 1.35; 755 participants; four studies; low-quality evidence). Fibrin sealants may also lead to little or no difference in postoperative mortality (0.3% versus 0.5%; Peto OR 0.52, 95% CI 0.05 to 5.03; 804 participants; six studies; low-quality evidence), or overall postoperative morbidity (28.5% versus 23.2%; RR 1.23, 95% CI 0.97 to 1.58; 646 participants; three studies; low-quality evidence). We are uncertain whether fibrin sealants reduce reoperation rate (2.0% versus 3.8%; RR 0.51, 95% CI 0.15 to 1.71; 376 participants; two studies; very low-quality evidence). There is probably little or no difference in length of hospital stay between the groups (12.1 days versus 11.4 days; MD 0.32 days, 95% CI -1.06 to 1.70; 755 participants; four studies; moderate-quality evidence). The studies did not report serious adverse events, quality of life, or cost effectiveness.Application of fibrin sealants to pancreatic anastomosis reinforcement after pancreaticoduodenectomyWe included three studies involving 251 participants: 115 were randomized to the fibrin sealant group and 136 to the control group after pancreaticoduodenectomy. We are uncertain whether fibrin sealants reduce postoperative pancreatic fistula (1.6% versus 6.2%; RR 0.25, 95% CI 0.01 to 5.06; 57 participants; one study; very low-quality evidence). Fibrin sealants may lead to little or no difference in postoperative mortality (0.1% versus 0.7%; Peto OR 0.15, 95% CI 0.00 to 7.76; 251 participants; three studies; low-quality evidence) or length of hospital stay (12.8 days versus 14.8 days; MD -1.58 days, 95% CI -3.96 to 0.81; 181 participants; two studies; low-quality evidence). We are uncertain whether fibrin sealants reduce overall postoperative morbidity (33.7% versus 34.7%; RR 0.97, 95% CI 0.65 to 1.45; 181 participants; two studies; very low-quality evidence), or reoperation rate (7.6% versus 9.2%; RR 0.83, 95% CI 0.33 to 2.11; 181 participants; two studies, very low-quality evidence). The studies did not report serious adverse events, quality of life, or cost effectiveness.Application of fibrin sealants to pancreatic duct occlusion after pancreaticoduodenectomyWe included two studies involving 351 participants: 188 were randomized to the fibrin sealant group and 163 to the control group after pancreaticoduodenectomy. Fibrin sealants may lead to little or no difference in postoperative mortality (8.4% versus 6.1%; Peto OR 1.41, 95% CI 0.63 to 3.13; 351 participants; two studies; low-quality evidence) or length of hospital stay (17.0 days versus 16.5 days; MD 0.58 days, 95% CI -5.74 to 6.89; 351 participants; two studies; low-quality evidence). We are uncertain whether fibrin sealants reduce overall postoperative morbidity (32.0% versus 27.6%; RR 1.16, 95% CI 0.67 to 2.02; 351 participants; two studies; very low-quality evidence), or reoperation rate (13.6% versus 16.0%; RR 0.85, 95% CI 0.52 to 1.41; 351 participants; two studies; very low-quality evidence). Serious adverse events were reported in one study: more participants developed diabetes mellitus when fibrin sealants were applied to pancreatic duct occlusion, both at three months' follow-up (33.7% fibrin sealant group versus 10.8% control group; 29 participants versus 9 participants) and 12 months' follow-up (33.7% fibrin sealant group versus 14.5% control group; 29 participants versus 12 participants). The studies did not report postoperative pancreatic fistula, quality of life, or cost effectiveness. AUTHORS' CONCLUSIONS Based on the current available evidence, fibrin sealants may have little or no effect on postoperative pancreatic fistula in people undergoing distal pancreatectomy. The effects of fibrin sealants on the prevention of postoperative pancreatic fistula are uncertain in people undergoing pancreaticoduodenectomy.
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Affiliation(s)
- Junhua Gong
- First Affiliated Hospital of Kunming Medical UniversityOrgan Transplant CenterNo. 295, Xi Chang RoadKunmingChina650032
| | - Sirong He
- Chongqing Medical UniversityDepartment of Immunology, College of Basic MedicineNo. 1 Yixue RoadChongqingChina450000
| | - Yao Cheng
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Nansheng Cheng
- West China Hospital, Sichuan UniversityDepartment of Bile Duct SurgeryNo. 37, Guo Xue XiangChengduChina610041
| | - Jianping Gong
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Zhong Zeng
- First Affiliated Hospital of Kunming Medical UniversityOrgan Transplant CenterNo. 295, Xi Chang RoadKunmingChina650032
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Abstract
BACKGROUND Pilonidal sinus disease is a common condition that mainly affects young adults. This condition can cause significant pain and impairment of normal activities. No consensus currently exists on the optimum treatment for pilonidal sinus and current therapies have various advantages and disadvantages. Fibrin glue has emerged as a potential treatment as both monotherapy and an adjunct to surgery. OBJECTIVES To assess the effects of fibrin glue alone or in combination with surgery compared with surgery alone in the treatment of pilonidal sinus disease. SEARCH METHODS In December 2016 we searched: the Cochrane Wounds Specialised Register; CENTRAL; MEDLINE; Embase and CINAHL Plus. We also searched clinical trials registries and conference proceedings for ongoing and unpublished studies and scanned reference lists to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) only. We included studies involving participants of all ages and studies conducted in any setting. We considered studies involving people with both new and recurrent pilonidal sinus. We included studies which evaluated fibrin glue monotherapy or as an adjunct to surgery. DATA COLLECTION AND ANALYSIS Two study authors independently extracted data and assessed risk of bias. We used standard methods expected by Cochrane. MAIN RESULTS We included four RCTs with 253 participants, all were at risk of bias. One unpublished study evaluated fibrin glue monotherapy compared with Bascom's procedure, two studies evaluated fibrin glue as an adjunct to Limberg flap and one study evaluated fibrin glue as an adjunct to Karydakis flap.For fibrin glue monotherapy compared with Bascom's procedure, there were no data available for the primary outcomes of time to healing and adverse events. There was low-quality evidence of less pain on day one after the procedure with fibrin glue monotherapy compared with Bascom's procedure (mean difference (MD) -2.50, 95% confidence interval (CI) -4.03 to -0.97) (evidence downgraded twice for risk of performance and detection bias). Fibrin glue may reduce the time taken to return to normal activities compared with Bascom's procedure (mean time 42 days with surgery and 7 days with glue, MD -34.80 days, 95% CI -66.82 days to -2.78 days) (very low-quality evidence, downgraded as above and for imprecision).Fibrin glue as an adjunct to the Limberg flap may reduce the healing time from 22 to 8 days compared with the Limberg flap alone (MD -13.95 days, 95% CI -16.76 days to -11.14 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). It is uncertain whether use of fibrin glue affects the incidence of postoperative seroma (an adverse event) (risk ratio (RR) 0.27, 95% CI 0.05 to 1.61; very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and imprecision). There was low-quality evidence that fibrin glue, as an adjunct to Limberg flap, may reduce postoperative pain (median 2 versus 4; P < 0.001) and time to return to normal activities (median 8 days versus 17 days; P < 0.001). The addition of fibrin glue to the Limberg flap may reduce the length of hospital stay (MD -1.69 days, 95% CI -2.08 days to -1.29 days) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for unexplained heterogeneity).A single RCT evaluating fibrin glue as an adjunct to the Karydakis flap did not report data for the primary outcome of time to healing. It is uncertain whether fibrin glue with the Karydakis flap affects the incidence of postoperative seroma (adverse event) (RR 3.00, 95% CI 0.67 to 13.46) (very low-quality evidence, downgraded twice for risk of selection, performance and detection bias and for imprecision). Fibrin glue as an adjunct to Karydakis flap may reduce length of stay but this is highly uncertain (mean 2 days versus 3.7 days; P < 0.001, low-quality evidence downgraded twice for risk of selection, performance and detection bias). AUTHORS' CONCLUSIONS Current evidence is uncertain regarding any benefits associated with fibrin glue either as monotherapy or as an adjunct to surgery for people with pilonidal sinus disease. We identified only four RCTs and each was small and at risk of bias resulting in very low-quality evidence for the primary outcomes of time to healing and adverse events. Future studies should enrol many more participants, ensure adequate randomisation and blinding, whilst measuring clinically relevant outcomes.
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Affiliation(s)
- Jon Lund
- University of NottinghamDivision of Health Sciences, School of MedicineMedical School, Royal Derby Hospital, Uttoxeter RoadDerbyUKDE22 3DT
| | - Samson Tou
- Royal Derby HospitalDepartment of Colorectal SurgeryUttoxeter RoadDerbyUKDE22 3NE
| | - Brett Doleman
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of NottinghamDepartment of Surgery and AnaesthesiaUttoxeter New RoadDerbyUKDE22 3DT
| | - John P Williams
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of NottinghamDepartment of Surgery and AnaesthesiaUttoxeter New RoadDerbyUKDE22 3DT
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18
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Khodakaram-Tafti A, Mehrabani D, Shaterzadeh-Yazdi H. An overview on autologous fibrin glue in bone tissue engineering of maxillofacial surgery. Dent Res J (Isfahan) 2017; 14:79-86. [PMID: 28584530 PMCID: PMC5443013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review is to have an overview on the applications on the autologous fibrin glue as a bone graft substitute in maxillofacial injuries and defects. A search was conducted using the databases such as Medline or PubMed and Google Scholar for articles from 1985 to 2016. The criteria were "Autograft," "Fibrin tissue adhesive," "Tissue engineering," "Maxillofacial injury," and "Regenerative medicine." Bone tissue engineering is a new promising approach for bone defect reconstruction. In this technique, cells are combined with three-dimensional scaffolds to provide a tissue-like structure to replace lost parts of the tissue. Fibrin as a natural scaffold, because of its biocompatibility and biodegradability, and the initial stability of the grafted stem cells is introduced as an excellent scaffold for tissue engineering. It promotes cell migration, proliferation, and matrix making through acceleration in angiogenesis. Growth factors in fibrin glue can stimulate and promote tissue repair. Autologous fibrin scaffolds are excellent candidates for tissue engineering so that they can be produced faster, cheaper, and in larger quantities. In addition, they are easy to use and the probability of viral or prion transmission may be decreased. Therefore, autologous fibrin glue appears to be promising scaffold in regenerative maxillofacial surgery.
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Affiliation(s)
- Azizollah Khodakaram-Tafti
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran,Address for correspondence: Prof. Azizollah Khodakaram-Tafti, Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran. E-mail:
| | - Davood Mehrabani
- Department of Pathology, Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Abstract
BACKGROUND Previous studies investigated the efficacy and applicability of tissue adhesives in gastrointestinal surgery while no evidence is available to date about a novel compound, TachoSil (Takeda, Zurich, Switzerland). The primary aim of this observational study was to assess the effect of new fibrin sealant on the incidence of postoperative complications in a homogeneous group of patients submitted to upper gastrointestinal surgery for cancer. METHODS Two cohorts of 28 and 34 patients undergoing upper gastrointestinal for surgery were compared. In the first cohort, the anastomotic site was treated with TachoSil fibrinogen-thrombin-collagen patches and in the second no collagen sponge or any other hemostatic sealant was used. Postoperative complications and outcomes as well as postoperative biochemical parameters were analyzed. RESULTS Postoperative complications occurred in 12 patients (35.3%) and 2 patients (7.1%) in control and collagen sponge group respectively (χ2 = 3.539, p < 0.05), with no anastomotic leakage in the collagen sponge group. A binary logistic regression analysis showed that the nonuse of collagen sponge [odds ratio (OR) = 0.025, 95% confidence interval (CI) = 0.001-0.457, p = 0.01] was independently associated with postoperative complication occurrence. CONCLUSIONS The addition of fibrinogen-thrombin-collagen sponge patch may reduce postoperative complication rate after upper gastrointestinal surgery for cancer. Further study to delineate the role of TachoSil in gastrointestinal surgery are also needed to demonstrate improved effectiveness and applicability.
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Affiliation(s)
- Luigi Marano
- a 8th General and Gastrointestinal Surgery -Department of Internal Medicine, Surgical , Neurological Metabolic Disease and Geriatric Medicine - Second University of Naples , Naples , Italy
| | - Natale Di Martino
- a 8th General and Gastrointestinal Surgery -Department of Internal Medicine, Surgical , Neurological Metabolic Disease and Geriatric Medicine - Second University of Naples , Naples , Italy
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20
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Park TH, Kim JK. Nonsurgical management of an enlarging pneumatocele by fibrin sealant injection via pigtail catheter. Pediatr Pulmonol 2016; 51:E5-7. [PMID: 26340670 DOI: 10.1002/ppul.23311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/29/2015] [Accepted: 08/22/2015] [Indexed: 11/08/2022]
Abstract
Most pneumatoceles disappear spontaneously and do not cause severe symptoms. Treatment alternatives include various conventional or surgical methods. However, an enlarging, complicated pneumatocele with cardiorespiratory instability requires imaging-guided catheter drainage or surgery. Here, we report the case of a newborn girl with an enlarging pneumatocele accompanied by pulmonary interstitial emphysema secondary to mechanical ventilation. The pneumatocele was successfully managed by the injection of fibrin sealant via a pigtail catheter.
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Affiliation(s)
- Tae Hyun Park
- Department of Pediatrics, Chonbuk National University Hospital, Jeonju, Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Chonbuk National University Hospital, Jeonju, Korea
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21
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Abstract
BACKGROUND In women undergoing in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), embryos transferred into the uterine cavity can be expelled due to many factors including uterine peristalsis and contractions, low site of deposition and negative pressure generated when removing the transfer catheter. Techniques to reduce the risk of embryo loss following embryo transfer (ET) have been described but are not standard in all centres conducting ET. OBJECTIVES To evaluate the efficacy of interventions used to prevent post-transfer embryo expulsion in women undergoing IVF and ICSI. SEARCH METHODS We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials to June 2014 and PubMed, MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, World Health Organization ICTRP, and trial registers from inception to June 2014, with no language restrictions. Additionally, we handsearched reference lists of relevant articles, and ESHRE and ASRM conference abstracts. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions used to prevent post-transfer embryo expulsion in women undergoing IVF and ICSI. Two review authors independently screened titles and abstracts and reviewed the full-texts of all potentially eligible citations to determine whether they met our inclusion criteria. Disagreements were resolved by consensus. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of included trials using standardised, piloted data extraction forms. Data were extracted to allow intention-to-treat analyses. Disagreements were resolved by consensus. The overall quality of the evidence was rated using GRADE methods. MAIN RESULTS We included four RCTs (n = 1392 women) which administered the following interventions: bed rest (two trials), fibrin sealant (one trial), and mechanical closure of the cervix (one trial). Our primary outcome, live birth rate, was not reported in any of the included trials; nor were the data available from the corresponding authors. For the ongoing pregnancy rate, two trials comparing more bed rest with less bed rest showed no evidence of a difference between groups (odds ratio (OR) 0.88; 95% confidence interval (CI) 0.60 to 1.31, 542 women, I(2) = 0%, low quality evidence). Secondary outcomes were sporadically reported with the exception of the clinical pregnancy rate, which was reported in all of the included trials. There was no evidence of a difference in clinical pregnancy rate between more bed rest and less bed rest (OR 0.88; 95% CI 0.60 to 1.31, 542 women, I(2) = 0%, low quality evidence) or between fibrin sealant and usual care (OR 0.98; 95% CI 0.54 to 1.78, 211 women, very low quality evidence). However, mechanical closure of the cervix was associated with a higher clinical pregnancy rate than usual care (OR 1.92; 95% CI 1.40 to 2.63, very low quality evidence). The quality of the evidence was rated as low or very low for all outcomes. The main limitations were failure to report live births, imprecision and risk of bias. Overall, the risk of bias of the included trials was high. The use of a proper method of randomisation and allocation concealment was fairly well reported, while only one trial clearly reported blinding. There was no evidence that any of the interventions had an effect on adverse event rates but data were too few to reach any conclusions. AUTHORS' CONCLUSIONS There is insufficient evidence to support any specific length of time for women to remain recumbent, if at all, following embryo transfer, nor is there sufficient evidence to recommend the use of fibrin sealants added to the embryo transfer fluid. There is very limited evidence to support the use of mechanical pressure to close the cervical canal following embryo transfer. Further well-designed and powered studies are required to determine the true effectiveness and safety of these interventions.
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Affiliation(s)
- Ahmed M Abou‐Setta
- University of ManitobaCentre for Healthcare InnovationGH‐714 820 Sherbrook StreetWinnipegMBCanadaR3A 1R9
| | - Leah R Peters
- University of LimerickGraduate Entry Medical SchoolLimerickIreland
| | - Arianna D'Angelo
- Cardiff University School of MedicineObstetrics and GynaecologyCardiffWalesUK
| | - Hassan N Sallam
- Alexandria UniversityObstetrics and Gynaecology22 Victor Emanuel SquareSmouhaAlexandriaEgypt21615
| | - Roger J Hart
- The University of Western Australia, King Edward Memorial Hospital and Fertility Specialists of Western AustraliaSchool of Women's and Infants' Health374 Bagot RoadSubiacoWestern AustraliaAustralia6008
| | - Hesham G Al‐Inany
- Faculty of Medicine, Cairo UniversityObstetrics & Gynaecology8 Moustapha Hassanin StManialCairoEgypt
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Ploussard G, Haddad R, Loutochin O, Bera R, Cabrera T, Malibari N, Scarlata E, Derbekyan V, Bladou F, Anidjar M. A combination of hemostatic agents may safely replace deep medullary suture during laparoscopic partial nephrectomy in a pig model. J Urol 2014; 193:318-24. [PMID: 25046623 DOI: 10.1016/j.juro.2014.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE We assessed whether a combination of the fibrin tissue adhesive Tisseel® (human fibrinogen and thrombin) plus the hemostatic matrix FloSeal® (bovine derived gelatin matrix/human thrombin) could safely replace the conventional deep medullary suture without compromising outcomes. MATERIALS AND METHODS Laparoscopic mid pole and one-third partial nephrectomy was performed on the right kidney of 12 female pigs. The only difference between the 2 groups of 6 pigs each was the use of a fibrin tissue adhesive plus hemostatic matrix combination in group 2 instead of the deep medullary running suture in control group 1. Renal scans and angiograms were performed at baseline and before sacrifice at 5-week followup. Retrograde in vivo pyelogram was also done. RESULTS No significant difference was seen in operative parameters or postoperative course between the groups. Renal scans revealed a statistically insignificant trend toward greater uptake loss in group 1 and angiograms showed 3 major vessel occlusions in that group. No active bleeding was detected. Those 3 kidneys had significantly poorer postoperative uptake on renal scan than that of other kidneys (18.6% vs 39.4%, p = 0.013). Only 1 small asymptomatic pseudoaneurysm was noted in group 1. No urine leakage was found in either group. No major vessel occlusion, pseudoaneurysm or urinary complications developed in group 2. CONCLUSIONS Even after deep one-third partial nephrectomy FloSeal with concurrent Tisseel appeared sufficient to control major medullary vascular injuries and replace the deep medullary conventional suture without compromising operative outcomes. The potential advantages seen during functional and vascular examinations by decreasing the risk of unnecessary segmental vessel occlusion need further clinical evaluation.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Richard Haddad
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oleg Loutochin
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rahul Bera
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tatiana Cabrera
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nouf Malibari
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Eleonora Scarlata
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vilma Derbekyan
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Franck Bladou
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Maurice Anidjar
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
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Abstract
The authors present the case of a 64-year-old woman who was referred for severe sacral pain. She reported that her pain had been longstanding, and had greatly increased after percutaneous fibrin glue placement therapy for a sacral meningeal cyst 2 months earlier at a different hospital. An MRI scan obtained immediately after fibrin glue placement at that hospital suggested that fibrin glue had migrated superiorly into the subarachnoid space from the sacral cyst to the level of L-4. On admission to the authors' institution, physical examination demonstrated no abnormal findings except for perianal hypesthesia. An MRI study obtained at admission demonstrated a cystic lesion in the peridural space from the level of S-2 to S-4. Inhomogeneous intensity was identified in this region on T2-weighted images. Because the cauda equina and nerve roots appeared to be compressed by the lesion, total cyst excision was performed. The cyst cavity was filled with fluid that resembled CSF, plus gelatinous material. Histopathological examination revealed that the cyst wall was composed of hyaline connective tissue with some calcification. No nervous tissue or ganglion cells were found in the tissue. The gelatinous material was acellular, and appeared to be degenerated fibrin glue. Sacral pain persisted to some extent after surgery. The authors presumed that migrated fibrin glue caused the development of adhesive arachnoiditis. The risk of adhesive arachnoiditis should be considered when this therapy is planned. Communication between a cyst and the subarachnoid space should be confirmed to be sufficiently narrow to prevent the migration of injected fibrin glue.
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Affiliation(s)
- Kazunori Hayashi
- Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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24
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Felema GG, Bryskin RB, Heger IM, Saswata R. Venous air embolism from Tisseel use during endoscopic cranial vault remodeling for craniosynostosis repair: a case report. Paediatr Anaesth 2013; 23:754-6. [PMID: 23746210 DOI: 10.1111/pan.12180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 01/05/2023]
Abstract
Venous air embolism (VAE) is a potential complication during cranial vault remodeling requiring early detection and prompt therapeutic intervention. The incidence of VAE has been reported to be as high as 82.6% during open craniectomy for craniosynostosis repair. On the other hand, two separate studies reported a much lower incidence of VAE (8% and 2%) during endoscopic strip craniectomy. As surgical advancements progress, minimally invasive neurosurgical procedures are increasing in the pediatric population with reported benefits of decreased blood loss and need for transfusion, shorter hospital stay, decreased cost, lower morbidity, and mortality. In addition, there is a heightened emphasis on achieving hemostasis, which has led to the use of products such as antifibrinolytics and fibrin sealants. We present a case where a VAE causing significant hemodynamic instability (grade III) ensued immediately following aerosolized fibrin sealant application. Exploration of the potential source of VAE pointed to the high pressure and close proximity (between spray device and tissue) during application of the sealant, likely forcing air into the vascular system.
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Affiliation(s)
- Gohalem G Felema
- Department of Pediatric Anesthesiology, Mayo Clinic/Nemours Children's Clinic, Jacksonville, FL 32207, USA
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25
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Lim JH, You D, Jeong IG, Park HK, Ahn H, Kim CS. Cystoscopic injection of N-butyl-2-cyanoacrylate followed by fibrin glue for the treatment of persistent or massive vesicourethral anastomotic urine leak after radical prostatectomy. Int J Urol 2013; 20:980-5. [PMID: 23387512 DOI: 10.1111/iju.12094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/26/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vesicourethral anastomotic urine leak is a common postoperative complication of radical prostatectomy. Herein we describe a novel method for the treatment of this complication. METHODS Intervention for a prolonged or massive anastomotic urine leak was required in 10 out of 1828 patients (0.5%) submitted to radical prostatectomy between 2007 and 2011. N-butyl-2-cyanoacrylate (Histoacryl) followed by fibrin glue (Greenplast) were injected under local anesthesia into vesicourethral anastomotic gaps under fluoroscopic guidance using a 20-Fr rigid cystoscope. Cystograms were taken in all patients to confirm complete urine leak resolution before the removal of the urethral catheter. RESULTS Cystoscopic injection of Histoacryl followed by fibrin glue was technically successful and well tolerated in all patients. The mean time from radical prostatectomy to glue injection was 16.0 days (range 12-27 days). Urethral catheterization was required for an average of 7.7 days after cystoscopic injection of fibrin glue (range 3-13 days). These measures ultimately enabled complete resolution of the urine leak in all cases. At a mean follow up of 23.3 months, all 10 patients were fully continent. The mean time to recovery of urinary continence was 20.4 weeks (range 3.9-60.0 weeks). CONCLUSIONS Cystoscopic injection of N-butyl-2-cyanoacrylate followed by fibrin glue into the anastomotic gap is both a feasible and effective solution in patients with a persistent or massive vesicourethral anastomotic urine leak after radical prostatectomy.
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Affiliation(s)
- Ju Hyun Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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